Every finding on record at Blessing Hospital

Upon patient record review, 2 of 19 (Patients #1 and 4) did not contain evidence that the Plan of Care included all services necessary for the palliation and management of the terminal illness and related conditions, including equipment and supply needs: Patient #1: During Surveyor-attended home visit on 01/10/24 it was noted that the patient had the following DME: 1) Hospital bed; 2) Overbed table; 3) Wheel chair; and 4) Wheeled walker. These items were not included on the POC. Patient #4: During Surveyor-attended home visit on 01/10/24 it was noted that the patient had the following DME: Shower chair. This item was not included on the POC.

Upon patient record review 4 of 19 (Patients #4, 8, 11, and 12) did not contain evidence that the Hospice Aide had provided care/services that were: • Ordered by the Interdisciplinary Group • Included in the Plan of Care • Permitted to be performed under state law by such hospice aide • Consistent with the hospice Aide training Patient #4: The current Aide POC assigned nail care QV. This intervention was not provided on the 12/18, 12/20, nor 12/22/23 Aide visits. Patient #8: The current Aide POC assigned: 1) Shave QV; 2) Nail care QV; 3) Oral care QV; 4) Linen change QV; and 5) Shower QV. The Aide did not provide shower, nail care, oral care, or linen change on 12/28/23. The Aide did not provide shower, nail care, or linen change on 01/04/24. Patient #11: The current Aide POC assigned: 1) Nail care QV; and 2) Oral care QV. The Aide did not provide nail care nor oral care on 12/12/23, 12/19/23 or 01/03/24. Patient #12: The current Aide POC assigned nail care QV. This intervention was not provided on 8 of 8 visits made between 11/24/23 and 01/09/24.

Upon patient record review 1 of 19 (Patient #3) did not contain evidence that the Hospice Aide reported: • Changes in the patient's medical, nursing, rehabilitative, and social needs to a Registered Nurse, as the changes relate to the Plan of Care and quality assessment and improvement activities • Hospice aides must also complete appropriate records in compliance with the hospice's policies and procedures Patient #3: During the Surveyor-attended home visit on 01/10/24, the Surveyor noted a 4-5" wide bandage on the patient's right arm, while the Aide was bathing the patient. The Aide reported that she had become aware of this wound site for the first time yesterday. When asked, the Aide confirmed that she had not reported this to the Hospice IDG/RN Case Manager.

Upon patient record review 2 of 19 (Patients #8 and 12) did not contain evidence that a Registered Nurse had made an on-site visit to the patient's home no less frequently than every 14 days to assess the quality of care and services provided by the Hospice Aide, and to ensure that services ordered by the Hospice Interdisciplinary Group meet the patient's needs: Patient #8: An Aide Supervisory visit was conducted on 12/11/23, and then not again until 12/26/23, for an interim period of 15 days. Patient #12: An Aide Supervisory visit was made on 12/05/23, and then not again until 01/05/24.

Upon patient record review, 2 of 19 (Patients #8 and 11) did not contain evidence that all entries were legible, clear, complete, and appropriately authenticated and dated in accordance with the organizations policies and procedures and currently accepted standards of practice: Patients #8 and 11: For both of these clinical records, none of the signatures entered by Aide (JF) included her credentials.

Upon patient record review, 2 of 19 (Patients #14 and 16) did not contain evidence that the Discharge Summary included all CMS-required information: Patients #14 and 16: Were discharged on 08/10/23 and 10/29/23 respectively. These DC Summaries did not contain the following required content: • A summary of the patient's stay, including treatments, symptoms and pain management • The patient's current Plan of Care • The patient's latest Physician orders

Upon patient record review, 1 of 19 (Patient #1) did not contain evidence that a written Hospice Plan of Care is established and maintained in consultation with SNF representatives. All Hospice care provided is in accordance with this Hospice Plan of Care: Patient #1: During the 01/10/24 Surveyor-attended home/SNF visit, the Hospice RN was observed providing wound care to the right lower extremity, below the knee. The POC effective 01/09/24 ordered wound care as, "Cleanse RLE wound QD with Normal Saline, pat dry, apply Calcium Alginate to wound bed, and cover with Opti-foam dressing. Change QD and when soiled or rolls, until healed." The Hospice RN swabbed the circumference of the wound with a Betadine swab prior to applying the Calcium Alginate. This was not part of the Physician-ordered wound process.

Upon patient record review, 2 of 19 (Patients #2 and 3) did not contain evidence that the Hospice had provided the following information to the SNF: • The most recent Hospice Plan of Care specific to each patient • The Election of Hospice Benefit form and any Advance Directives specific to each patient • Physician certification and recertification of the terminal illness specific to each patient • Names and contact information for hospice personnel involved in hospice care of each patient • Instructions on how to access the hospice's 24-hour on-call system • Hospice medication information specific to each patient • Hospice Physician and Attending Physician (if any) orders specific to each patient Patients # 2 and 3: During Surveyor-attended home/SNF visits, the Hospice Clinical Manager was not able to locate evidence that the Hospice had provided the SNF with the following CMS-required documents: 1) The Election of Hospice Benefit form; and 2) The Physician certification and re-certification of the terminal illness documents.